β-Lactam vs Non-β-Lactam Antibiotics and Surgical Site Infection in Colectomy Patients

Abstract Background Surgical site infections (SSI) represent a significant preventable source of morbidity, mortality and cost. Prophylactic antibiotics have been shown to decrease SSI rates, and β-lactam antibiotics are recommended by national guidelines. It is currently unclear whether recommended β-lactam and recommended non-β-lactam antibiotic regimens are equivalent with respect to SSI risk reduction in colectomy patients. Study Design Retrospective cohort study of SSI rates between prophylactic intravenously administered recommended β-lactam and non-β-lactam in colectomy patients (25 CPT codes) collected by the Michigan Surgical Quality Collaborative (MSQC) from January 2013 to February 2018. SSI rates were compared as a dichotomous variable (no SSI vs SSI). Mixed effects regression was used to compare the association between receiving a β-lactam or non-β-lactam antibiotic and likelihood of having an SSI. Results Out of 9,949 patients, 9,411 (94.6%) received β-lactam antibiotics, and 538 (5.4%) received non-β-lactam antibiotics. Overall, there were 622 (6.6%) patients with SSI. Of the patients receiving β-lactam antibiotics, 571 (6.1%) developed an SSI, compared to 51 (9.5%) of patients in the non-β-lactam group. After applying mixed-effects logistic regression, prophylactic treatment with a non-β-lactam regimen was associated with a significantly higher odds of surgical site infection (OR = 1.65; 95% CI=1.20-2.26; p Conclusion Colectomy patients receiving β-lactam antibiotics had a lower likelihood of surgical site infection compared to those receiving non-β-lactam antibiotics, even when antibiotics were compliant with national recommendations. Our findings suggest that surgeons should prescribe β-lactam antibiotics for prophylaxis whenever possible, reserving alternatives for those rare patients with true allergies or clinical indications for non-β-lactam antibiotic prophylaxis.